Safinamide Mesylate interactions

Food & lifestyle

• Tyrosine-rich foods

  Major

  Synergy

  Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules. Although safinamide is considered a selective inhibitor of MAO-B, the selectivity may not be absolute even at recommended dosages.

  What to do: Patients treated with safinamide should avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of safinamide therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should also be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. The recommended dosages of safinamide should not be exceeded, as it can increase the risk of nonselective MAO inhibition and a hypertensive crisis.

  1 source

  1. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of central nervous system (CNS)-active agents. Use in combination may result in additive CNS depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled against driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  5 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  5. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Safinamide Mesylate needs care, as documented in this source.

• Hepatic Insufficiency

  Major

  Safinamide is contraindicated in patients with severe hepatic dysfunction (Child-Pugh C). In patients with moderate hepatic impairment the maximum recommended dose is 50 mg orally once a day. If a patient taking this dose progresses from moderate to severe hepatic impairment, safinamide should be discontinued.

  1 source

  1. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Hypotension

  Major

  Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension, especially during dose escalation. Therapy with dopamine agonists should be monitored carefully in patients with Parkinson's disease since they may have an impaired ability to respond to an orthostatic challenge, and also in patients receiving antihypertensive drugs.

  11 sources

  1. Hoehn MM "Levodopa-induced postural hypotension. Treatment with fludrocortisone." Arch Neurol 32 (1975): 50-1
  2. Iwasaki S, Hamaguchi K, Iwasaki A, Takakusagi M, Narabayashi Y "Hypotensive effect of long-term levodopa in patients with Parkinson's disease." Eur Neurol 30 (1990): 194-9
  3. "Product Information. Dostinex (cabergoline)." Pharmacia and Upjohn (2001):
  4. "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals (2001):
  5. "Product Information. Sinemet CR (carbidopa-levodopa)." DuPont Pharmaceuticals (2001):
  6. "Product Information. Mirapex (pramipexole)." Boehringer Ingelheim (2001):
  7. "Product Information. Requip (ropinirole)." SmithKline Beecham (2001):
  8. "Product Information. Comtan (entacapone)." Novartis Pharmaceuticals (2001):

  Show all 11 sourcesShow fewer sources

  9. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  10. "Product Information. Neupro (rotigotine)." Schwarz Pharma (2007):
  11. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Psychotic Disorders

  Major

  Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinson agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs.

  8 sources

  1. "Product Information. Dostinex (cabergoline)." Pharmacia and Upjohn (2001):
  2. "Product Information. Mirapex (pramipexole)." Boehringer Ingelheim (2001):
  3. "Product Information. Requip (ropinirole)." SmithKline Beecham (2001):
  4. "Product Information. Comtan (entacapone)." Novartis Pharmaceuticals (2001):
  5. "Product Information. Lodosyn (carbidopa)." DuPont Pharma (2001):
  6. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  7. "Product Information. Neupro (rotigotine)." Schwarz Pharma (2007):
  8. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Hypertension

  Moderate

  Safinamide may cause hypertension or exacerbate existing hypertension. Patients should be monitored for new onset hypertension or hypertension that is not adequately controlled after starting treatment. Dosage adjustment may be necessary if elevation of blood pressure is sustained.

  1 source

  1. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Retinal Diseases

  Moderate

  Animal studies with safinamide showed retinal degeneration, loss of photoreceptor cells, cataracts, and retinal scarring. Patients should be periodically monitored for visual changes, especially if they have a history of retinal/macular degeneration, uveitis, inherited retinal conditions, family history of retinal disease, albinism, retinitis pigmentosa, or active retinopathy (e.g., diabetic retinopathy).

  1 source

  1. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):